SPI Insights

Last week, President Donald Trump signed a bill extending the Veterans Choice Program beyond its Aug. 7 end date. In August 2014, President Barrack Obama signed the initial bill into law. The Veterans Access, Choice and Accountability Act is intended to speed veterans’ access to health care by directing Department of Veterans Affairs (VA) to establish a program to furnish hospital care and medical services through eligible non-VA healthcare providers. Veterans who qualify for the service either have been or will be waiting more than 30 days for VA medical care, lives more than 40 miles away from a VA medical care facility or faces one of several excessive travel burdens.

This should come as a relief for thousands of veterans residing in Texas. There are 15 major military installations and several military reserve facilities and national guard camps located in Texas. In 2014, Harris County was home to 187,235 veterans. Other counties with the largest numbers of veterans in 2014 were Bexar, Tarrant, Dallas, Collin, Travis, Bell, El Paso, Denton, and Montgomery. Over 40 percent of the state’s veteran population resided in these 10 counties. While the median age of a veteran in Texas is 63, approximately half of the estimated 22,000 Texas residents that separated from the military in fiscal year 2015 were 24 years old or younger.

As military personnel continue to separate from the ranks of enlisted through officer, the need for health care continues to surge. Will the Veterans Choice program be able to keep pace with the demand? Some changes being implemented in the program, called “Choice 2.0,” will include relaxed eligibility rules, more outside care options and billions more in funding to cover the costs of outside appointments.

The VA lifted restrictions on new hires for several of its positions on Wednesday following the White House’s decision to formally end the hiring freeze that had been in place since the start of the Trump administration. An internal department memo, obtained by the Associated Press, stated that thousands of jobs would still be left vacant unless they were approved by top VA leadership as addressing an “absolute critical need.” This includes 4,000 in the Veterans Health Administration and 200 in Veterans Benefits Administration, plus more than 400 in the office of the assistant secretary for information and technology and 100 human resources positions.

Trump signed an executive order Thursday seeking to provide more protections to whistle-blowers at the VA. The order will create a new office at the VA that will investigate allegations of misconduct, including retaliation against whistle-blowing employees who reported abuses. Trump also called on the Senate to pass pending accountability legislation, already approved by the House, that would give VA Secretary David Shulkin more authority to remove low-performing employees or those accused of misconduct.

A bill was introduced this week in the U.S. House of Representatives by Reps. Julia Brownley and Glenn Thompson called the Veterans E-Health & Telemedicine Support Act of 2017. A companion bill was introduced in the Senate by Sens. Joni Ernst and Mazie Hirono. If the bill became law, it would allow VA health professionals to practice telehealth across state lines, as long as they are qualified and practice within the scope of their authorized federal duties. Also, veterans would no longer be required to travel to a VA facility and instead could receive telemedicine treatment from any location, including their home or community center.

According to an analysis conducted by the VA, 65 percent of veterans who died from suicide in 2014 were 50 years of age or older. The analysis was based on examining over 55 million veteran records from 1979 to 2014 from every state in the nation. In 2001, the rate of suicide among male veterans who use VA services increased 11 percent, while the rate of suicide increased by 35 percent among male veterans who do not use VA services. In the same time period, the rate of suicide among female veterans who use VA services increased 4.6 percent, while the rate of suicide increased 98 percent among female veterans who do not use VA services.

Last year, Sen. Deb Fischer and Rep. Brad Ashford, passed legislation called the CHIP IN for Vets Act. The two officials had been pushing the idea of a public-private partnership to remedy the backlog of veterans in need of medical treatment. The bill makes it possible for communities to take the lead and manage the construction of VA projects, contributing to the financing already provided by the federal government in order to ensure that the projects are completed on time.

The city of Omaha, Neb. has embraced this idea and the result is a new health care facility for veterans. The Veterans Ambulatory Center Development Corporation and Omaha business leaders have committed $30 million to a partnership with the VA to build an ambulatory clinic on the grounds of the Omaha VA hospital. The project would include $56 million previously appropriated by Congress with the $30 million raised locally to build the complex for the VA Nebraska/Western Iowa Health Care System on its campus near 42nd Street and Woolworth Avenue. VA officials have said it would offer primary, specialty and ambulatory care as well as radiology and surgery suites. Design work on the Omaha project will continue through this year, but site work and construction are expected to begin in early 2018.

In Radcliff, Ill., Mayor Mike Weaver provided a free 50-acre site to the VA that is located in the city’s Millpond Business Center. This public-private partnership is expediting construction of a new VA medical center that has been under discussion for more than a decade. Weaver is working with retired surgeon and investor Dr. Robert Robbins, and other partners interested in the concept. The funding plan is being developed and Robbins will present it to Shulkin in the coming weeks. The partnership also includes Hardin Memorial Health, the University of Kentucky and University of Louisville hospitals, Elizabethtown Community and Technical College and Western Kentucky University.

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